Cardiac output and the pharmacology of general anesthetics: a narrative review
The relationship between cardiac output and anesthetic drugs is important to anesthesiologists, since cardiac output determines the speed with which a drug infused into the bloodstream reaches its target and the intensity of the drug’s effect. But rather than focus on how anesthetic drugs affect ca...
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| Format: | Article |
| Language: | English |
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Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E
2023-05-01
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| Series: | Colombian Journal of Anesthesiology |
| Subjects: | |
| Online Access: | https://www.revcolanest.com.co/index.php/rca/article/view/1074 |
| _version_ | 1797632911104540672 |
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| author | Elena Simón-Polo Jose Vicente Catalá-Ripoll José Ángel Monsalve-Naharro Manuel Gerónimo-Pardo |
| author_facet | Elena Simón-Polo Jose Vicente Catalá-Ripoll José Ángel Monsalve-Naharro Manuel Gerónimo-Pardo |
| author_sort | Elena Simón-Polo |
| collection | DOAJ |
| description | The relationship between cardiac output and anesthetic drugs is important to anesthesiologists, since cardiac output determines the speed with which a drug infused into the bloodstream reaches its target and the intensity of the drug’s effect. But rather than focus on how anesthetic drugs affect cardiac output, this narrative review focuses on how changes in cardiac output affect the pharmacokinetics and pharmacodynamics of general anesthetics during the three phases of anesthesia.
At induction, an increase in cardiac output shortens both the onset time of propofol for hypnosis and the neuromuscular blocking effect of rapid-acting neuromuscular blockers, favoring the conditions for rapid sequence intubation.
During maintenance, changes in cardiac output are followed by opposite changes in the drug plasma concentration of anesthetic drugs. Thus, an increase in cardiac output followed by a decrease in the plasma concentration of the anesthetic could expose the patient to a real risk of intraoperative awakening, which can be avoided by increasing the dose of hypnotic drugs.
At emergence, an increase in cardiac output secondary to an increase in pCO2 allows for a more rapid recovery from anesthesia. The pCO2 can be increased by adding CO2 to the respiratory circuit, lowering the ventilatory rate, or placing the patient on partial rebreathing. Finally, the reversal action of sugammadex for rocuronium-induced neuromuscular block can be shortened by increasing the cardiac output. |
| first_indexed | 2024-03-11T11:44:25Z |
| format | Article |
| id | doaj.art-3b8215b01db644cda2d15dc4a6e05e5f |
| institution | Directory Open Access Journal |
| issn | 2422-0248 2256-2087 |
| language | English |
| last_indexed | 2024-03-11T11:44:25Z |
| publishDate | 2023-05-01 |
| publisher | Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E |
| record_format | Article |
| series | Colombian Journal of Anesthesiology |
| spelling | doaj.art-3b8215b01db644cda2d15dc4a6e05e5f2023-11-09T16:27:37ZengSociedad Colombiana de Anestesiología y Reanimación S.C.A.R.EColombian Journal of Anesthesiology2422-02482256-20872023-05-0151410.5554/22562087.e10742068Cardiac output and the pharmacology of general anesthetics: a narrative reviewElena Simón-Polo0https://orcid.org/0000-0002-0411-334XJose Vicente Catalá-Ripoll1https://orcid.org/0000-0002-3678-8763José Ángel Monsalve-Naharro2https://orcid.org/0000-0002-7141-5460Manuel Gerónimo-Pardo3https://orcid.org/0000-0001-9911-7572Department of Anesthesiology, Gerencia de Atención Integrada. Albacete, Spain.Department of Anesthesiology, Gerencia de Atención Integrada. Albacete, Spain.Department of Anesthesiology, Gerencia de Atención Integrada. Albacete, Spain.Department of Anesthesiology, Gerencia de Atención Integrada. Albacete, Spain.The relationship between cardiac output and anesthetic drugs is important to anesthesiologists, since cardiac output determines the speed with which a drug infused into the bloodstream reaches its target and the intensity of the drug’s effect. But rather than focus on how anesthetic drugs affect cardiac output, this narrative review focuses on how changes in cardiac output affect the pharmacokinetics and pharmacodynamics of general anesthetics during the three phases of anesthesia. At induction, an increase in cardiac output shortens both the onset time of propofol for hypnosis and the neuromuscular blocking effect of rapid-acting neuromuscular blockers, favoring the conditions for rapid sequence intubation. During maintenance, changes in cardiac output are followed by opposite changes in the drug plasma concentration of anesthetic drugs. Thus, an increase in cardiac output followed by a decrease in the plasma concentration of the anesthetic could expose the patient to a real risk of intraoperative awakening, which can be avoided by increasing the dose of hypnotic drugs. At emergence, an increase in cardiac output secondary to an increase in pCO2 allows for a more rapid recovery from anesthesia. The pCO2 can be increased by adding CO2 to the respiratory circuit, lowering the ventilatory rate, or placing the patient on partial rebreathing. Finally, the reversal action of sugammadex for rocuronium-induced neuromuscular block can be shortened by increasing the cardiac output.https://www.revcolanest.com.co/index.php/rca/article/view/1074anesthetics, generalanesthetics, intravenousblood circulationcardiac outputpharmacokineticsanesthesiology |
| spellingShingle | Elena Simón-Polo Jose Vicente Catalá-Ripoll José Ángel Monsalve-Naharro Manuel Gerónimo-Pardo Cardiac output and the pharmacology of general anesthetics: a narrative review Colombian Journal of Anesthesiology anesthetics, general anesthetics, intravenous blood circulation cardiac output pharmacokinetics anesthesiology |
| title | Cardiac output and the pharmacology of general anesthetics: a narrative review |
| title_full | Cardiac output and the pharmacology of general anesthetics: a narrative review |
| title_fullStr | Cardiac output and the pharmacology of general anesthetics: a narrative review |
| title_full_unstemmed | Cardiac output and the pharmacology of general anesthetics: a narrative review |
| title_short | Cardiac output and the pharmacology of general anesthetics: a narrative review |
| title_sort | cardiac output and the pharmacology of general anesthetics a narrative review |
| topic | anesthetics, general anesthetics, intravenous blood circulation cardiac output pharmacokinetics anesthesiology |
| url | https://www.revcolanest.com.co/index.php/rca/article/view/1074 |
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